Portal-Systemic Shunts in Patients with Cirrhosis

Abstract

The purpose of this progress report is to make a critical review of the current indications of portal-systemic shunts in cirrhotic patients and to emphasize the necessity (and the difficulties) of controlled clinical trials. The following items were successively studied: (1) portacaval shunt in patients with intractable ascites; (2) prophylactic portacaval shunt; (3) emergency portal-systemic shunts, and (4) elective portal-systemic shunts.

Bleeding Oesophageal Varices

“…As over half the patients had a previous haernorrhage with identified varices, the superficial answer would be more, and earlier, therapeutic shunts. However, the controlled studies of Resnick et alii (1974) and Jackson et aiii (1971), using elective therapeutic shunts, fail to show any definite statistical advantage in total portal systemic diversions (Rueff and Maillard, 1974). The results of Zeppa et a& (1 977), using elective distal splenorenal shunts, are impressive, but their patients were a highly selected group.…”

“…However, these were all in the Child's A or B category. Urgent shunts had the expected high early mortality (Keighley et alii, 1973;Rueff and Maillard, 1974) of 40%, with the cause of death usually related to hepatic decompensation. Poor liver function was also shown by a further two deaths due to hepatic failure, and two patients who remain severely encephalopathic in the period of review.…”